Summary

This study provides a comprehensive analysis of boxing-related musculoskeletal injuries in the US over the past two decades, revealing a persistent high rate of upper extremity injuries, particularly among young male boxers, and underscores the need for improved safety protocols and targeted prevention strategies.

Abstract

Objective

Boxing-related musculoskeletal (MSK) injuries in the US have been understudied despite the sport’s growing popularity and associated risks. With USA Boxing membership reaching record highs, understanding the injury landscape is crucial. This study aimed to determine the incidence of boxing injuries, identify risk factors, and analyze trends in boxing-related injuries over the past two decades. By examining a nationally representative injury database from 2004-2023, this study provides a comprehensive overview of injury patterns, evaluates the impact of recent safety regulations, and offers insights for developing targeted interventions to enhance the safety and well-being of boxing participants.

Methods

Data was retrospectively collected from the National Electronic Injury Surveillance System (NEISS) database, which gathers data from approximately 100 representative emergency departments (EDs) across the United States. A query for boxing-related injuries from 2004 to 2023 extracted variables such as patient age, gender, injury type and location, and hospital disposition. Narratives were reviewed to isolate injuries sustained during active boxing participation. National estimates were calculated and statistical analysis was performed using descriptive analyses and chi-square tests with significance set at p<0.05.

Results

A total of 6192 boxing-related MSK injuries were reported, corresponding to a national estimate of 237,683 injuries over the 20-year period and an annual average of 11,884 injuries. Most injuries occurred in males aged 20-39 and under 20 years. The most common injuries included fractures (29.7%), strains/sprains (27.4%), and contusions/abrasions (23.2%), predominantly affecting upper extremities (66.4%). The most commonly injured body parts included the hand (32%), face (12.2%), wrist (12%), shoulder (9.3%), finger (8.5%), and head (5.9%). The hand accounted for more than half of both fractures and contusions, while the wrist was the most commonly strained/sprained body part (32.6%). Patients younger than 20 years accounted for the highest proportion of concussions (64.4%), dislocations (51.4%), and strains/sprains (46.7%). Patients between 20-39 represented the highest proportions of lacerations (60.8%), fractures (50.5%), and contusions/abrasions (50.4%). Between genders, males were more likely to sustain fractures (p=0.0001) while females were more likely to sustain strains (p=0.0045). The proportion of face injuries was higher in males compared to females (p<0.001), while females had a higher proportion of wrist injuries (p=0.0022). Injuries showed a slight overall decline from 2004 to 2023, with the highest decline (25.76%) occurring between 2019 and 2020.

Conclusions

Despite a decreasing trend in overall injuries, the persistence of high rates of upper extremity injuries, particularly among young male boxers, highlights the need for ongoing evaluation and refinement of boxing safety protocols. Enhanced protective gear, improved training techniques, and better enforcement of safety regulations could help reduce injury rates. Additionally, education programs focusing on injury prevention and early recognition are crucial. Future research should explore specific injury mechanisms and long-term health outcomes to inform effective safety guidelines.